The collected opinions of an august and aristocratic personage who, despite her body having succumbed to the ravages of time, yet retains the keen intellect, mordant wit and utter want of tact for which she was so universally lauded in her younger days.
Being of a generation unequal to the mysterious demands of the computing device, Lady Bracknell relies on the good offices of her Editor for assistance with the technological aspects of her journal.

Monday, May 04, 2009

Chestnuts roasting on an open fire

BADD is good and BADD is necessary, but it don't half expose some hoary old chestnuts. I'm pinning this one on Jack, because his was one of the first posts published this year, but I'm quite prepared to believe that others have fallen into exactly the same trap - I just haven't worked my way through to the offending posts yet.

Here's what Jack says:-

“Of course, the social model of disability tells us that they are disabled by society: that while they might have very poor hearing, for example, this would not represent a problem, were it not for the fact society does not generally adapt enough to their needs. The medical model of disability would say that the people are disabled by the fact that they have very poor hearing. My personal belief is that both models are appropriate, depending upon the circumstances: for example, the social model deals most effectively with disability discrimination (and preventing it); the medical model is better used by the medical profession when looking at the condition in question…”

I've tried not to react to this. I really have. But it's been eating away at me since Friday morning, and I can't leave it alone any longer. So, Jack, much as I love you, here goes nuffin'...

Let’s start with the basics. Models of disability are sociological models. In other words, they are models of the position those of us who have impairments hold within society. That is both what they are and all they are. They’re not designed to do anything. With the exception of the social model, they are reflections of existing attitudes. Also, with the exception of the social model, sociologists didn’t sit down and devise them. The medical, tragedy and charity models weren’t called the medical, tragedy or charity models until after the social model was drawn up, at which point terms were needed to define pre-existing responses to disability.

To say that the social model view of very poor hearing is that it wouldn’t represent a problem were it not for the fact that society doesn’t adapt to the needs of people with very poor hearing is, I’m afraid, a misunderstanding of the social model. The social model distinguishes between impairment (the very poor hearing) and disability (society’s failure to adapt to the needs of those with very poor hearing), certainly. What it doesn’t do is to say that having very poor hearing isn’t inherently a problem.

Hearing is probably the worst of all possible choices of example, as it happens, because many Deaf people are firmly of the belief that an inability to hear simply isn’t an inherent impediment to quality of life. So let’s use diabetes instead.

Does my diabetes present a problem? Hell, yes. And lots of them. Would it continue to present problems if society treated those of us with diabetes as true equals, and encouraged us to eat whenever we need to, even if doing so interrupted a meeting/appointment/social event? Absolutely, it would. Diabetes is a constant, tyrannical presence in my life which robs me of what little spontaneity my chronic pain might have left me with. Ignore the demands of my diabetes, and I die. No amount of societal commitment to full disability equality will alter that hard fact.

The social model of disability recognizes both the existence of impairments and the depth and breadth and extent of their impact on the individual. But it doesn’t dwell on that aspect of being a disabled person because that’s not what it was designed to illustrate. Instead, it differentiates between impairment (a lack of, or difference in, function – the stuff that can’t be changed) and the oppressive and exclusive nature of disability (society’s failure to treat people who have impairments as equals – the stuff that can be changed.)

By implication, because it demands equality of participation in society, the social model treats each and every impairment as morally-neutral. (This is comparable to the fight for genuine race equality, in which it is the reaction to differences in skin colour which causes exclusion, not the differences in skin colour themselves.) Morally-neutral or not – and that moral neutrality is a huge step forward in comparison with the belief that having an impairment is punishment for ill behaviour in a previous life – the impairment isn’t going anywhere. And neither are the problems it brings with it. But what we can eliminate – in theory, at least – are all the additional problems created by a society which treats people with impairments as abnormal and lesser beings. In other words, we can’t get rid of impairment, but we can and should eradicate disability. Just as we should eradicate racism, homophobia and sexism.

The phrase “abnormal and lesser beings” brings me neatly back to the medical model. I know I’ve said this before, but the medical model has been perilously-badly named. As it stands, it sounds as though it’s about providing medical care to people with impairments. Nuh-uh. It is nothing of the kind. If we could rename it the “Dear God, you can’t expect me to live next door to that!” model, then people like Jack would be far less likely to conclude that the two models can happily exist together in tandem.

Under the medical model of disability, you “have a disability” if there is something fairly seriously medically “wrong with” you. Having something “wrong with” you diminishes your position in society. It reduces your rights. Under the medical model, there is no obligation on society to adapt the general environment so that it’s accessible to you. Such obligation as there is lies with the medical profession – hence, “medical model”. Their job is to normalise you; to change and improve you until you fit in. Can’t be done in your particular situation? Oh, shame. Well, in that case, you get to be hidden away, either in your own home or in an institution, so that normal people – the ones with rights – aren’t exposed to your hideous deformities and distressing tics.

So, no, actually, I don’t think “the medical model is better used by the medical profession”. In fact, if I believed for even a fraction of a moment that my osteopath, acupuncturist, GP or diabetes nurse regarded me as an aberration who needs to be changed to fit in with normal society, I would be out of that treatment room as fast as my stick could carry me. There is an incalculably-huge difference between providing necessary medical treatment to someone with impairments and believing that, unless and until that treatment can make them look and behave like a normal person, they are inherently inferior.

16 Comments:

Thank you (yet again) for another extremely useful (and educational) post!! I learnt about the social model some time ago, I've read about the social model in various places, but I've not seen it laid out in quite this way, and you've answered a few niggling questions I've always had at the back of my mind. Somehow I had failed to pick up that the various models describe how people with impairments are TREATED, rather than how they ARE. At least, I hope I've got that right now! If so, it clears things up greatly.

I'll hold my hands up to the word "problem" being a poor choice there. I guess what I meant to say there was that this would not be a problem that they would be disabled by. Obviously 'tis an impairment and a problem.

That was a - if you'll excuse the repetition - problem of phrasing rather than understanding. I will adjust the phrasing of the original article to correct that...

However, disability (or indeed any other form of discrimination) is not a simple issue, as indeed we both know.

One area where I will disagree with you is on the issue of language: "disabled person" vs "person with a disablity". I accept one can relate more to one model than another, but I personally see the semantics as a distraction from what is important (I've seen enough cases in the web accessibility field where people fighting tbe same corner end up virtual enemies because they disagree with a particular term to believe that semantics are more important than actions).

Also, because I'm an arsey so and so, there's a possibility that I'll use particular terms deliberately to stir things up now and again. For example, whenever talking to a web standardista, mention the alt "tag". That always annoys 'em.

Finally - and I suspect we will probably fundamentally disagree here - I don't see what is wrong with the way the UK DDA uses it (taken from Wikipedia):

"the Disability Discrimination Act defines disability using the medical model - disabled people are defined as people with certain conditions, or certain limitations on their ability to carry out ‘normal day-to-day activities.’ But the requirement of employers and service providers to make ‘reasonable adjustments’ to their policies or practices, or physical aspects of their premises, follows the social model."

And if we can't agree; hell, I'd like to think there's room for more than one opinion in the world...

Yes, that's right. The models identify the reasons why we are excluded from full participation in society.

Under the medical model, our exclusion is the direct result of our medical "abnormality": it places the fault directly with us and our resultant inability to engage with a society which is designed solely for the participation of normies. With the result, of course, that those of us who can neither be cured nor are able to pass as "normal" will be forever excluded.

The social model, on the other hand, places the blame for our exclusion from society with society itself. Namely, with society's failure to adjust its attitudes and its environment to make it possible for us to participate equally.

As I said, it's somewhat akin to the difference between regarding having black skin as an indicator of inherent racial inferiority and recognising - and rejecting - the complex, historical reasons behind a negative response to people whose skin is black.

I would be truly appalled to discover that anybody I know is a white supremacist. But I know a great many people - my parents included - who take a medical model approach to disability.

I can assure you that I was not attacking you specifically. Unfortunately, any statement to the effect that the social and medical models can comfortably co-exist is like a red rag to a bull to me. My particular concern in this instance was that, if somebody as intelligent as you can be misled into that way of thinking, then it must be very prevalent indeed.

I didn't address the main thrust of your blog entry which is, of course, that it is entirely possible - and much too easy - to concentrate on the use of language to the detriment of the provision of genuine accessibility. That's inarguable, other than to express a hope that the bodies concerned could get both aspects right. I assume that issue is equally prevalent with the other equality strands, given that it derives from a position of wishing to be seen to have ticked boxes rather than one of wishing to ensure genuine equality of treatment for all.

You won't be surprised to learn that I have many concerns about the DDA and that those concerns extend - although are certainly not limited to - its definition of a disabled person being couched in such medical terms.

But note that I say "medical" rather than "medical model", there. Given that, without impairment, disability would not exist, there are serious drafting challenges in producing a legal definition of a disabled person - i.e. someone who is subjected to discrimination for reasons deriving from disability - without making a direct reference to the underlying medical differences.

Referencing my medical problems does not have to be done from a medical model perspective. In other words, unlike Wally-by-name, who has just commented on my BADD post, it's entirely possible to recognise that my injuries limit my mobility without concluding that, on the day I was injured, I lost all my rights to being considered an equal to people who have not been injured.

And I know that you do consider me to be an equal, which means that I respect your views on equality.

I just think you've fallen into the very common trap of equating the medical model with the provision of medical treatment and have therefore, perhaps, failed to recognise that, taken to its logical extreme, it is the model which results in people with impairments being badged as "useless eaters" and sent to the gas chambers.

I found you through BADD and added you to my feed reader, and this post demonstrates why I did.

In other words, as Rachael said: thank you for the educational post (and your additional comments)! And also, useful post, because I think it outlines the problems with the medical model in a way that can easily be used to challenge someone's ablism (and maybe even to show why they should not be ablist).

It's a self-evident distinction to me, but I still don't think I've found a way of expressing it which will necessarily clarify the point to those who have been seduced by the name of the offending model...

Lady Bracknell, I found your blog when I went through my favorites on my etsy site and low and behold, WOW, you are fantastic!! A force to be reckoned with. This is such a small token of appreciation but I would proudly love for you to wear my Coco Tan earrings if you will have them. I will convo you on Etsy. I love your incredible writing and your passion for creativity and life. Keep up the great work! Liza at Latigo Moon